(AS2) Comparing Those Most Satisfied versus Least Satisfied Following Surgery for Cervical Spondylotic Myelopathy: Are There Differences in Baseline Characteristics?
Assistant Professor of Neurological Surgery (in Orthopaedic Surgery) Columbia University Medical Center New York, New York, United States
Disclosure(s):
Andrew K. Chan, MD: No financial relationships to disclose
Introduction: Though most patients operated for cervical spondylotic myelopathy (CSM) are satisfied with their surgical results, there are a minority that remain dissatisfied. We sought to identify factors predicting the most (and least) satisfaction following surgery for CSM.
Methods: We retrospectively reviewed prospectively-collected data from the CSM Quality Outcomes Database (QOD) module. Baseline and surgical characteristics were compared for patients with CSM reporting the most [North American Spine Society Satisfaction Score (NASS) 1] and least (NASS 4) satisfaction 24 months postoperatively. A multivariable logistic model was constructed using backward elimination to determine significant predictors of most versus least satisfaction. Twenty-four-month patient-reported outcomes (PROs; ODI, NRS-BP, NRS-LP, EQ-5D) were compared.
Results: Overall, 1,141 patients were prospectively enrolled. Of these, 610 (87.3%) were most satisfied and 89 (12.7%) were least satisfied. Though there were mean improvements in all 24-month PROs for the most satisfied (p < 0.001), there were no significant improvements for the least satisfied (p>0.05, compared to baseline). Using multivariable logistic modeling, a preoperative symptom of upper extremity weakness (OR=2.5,p=0.003), subjective myelopathy (OR=2.0,p=0.04), the absence of numbness complaints (OR=2.2,p=0.003), symptom duration under 1 year (OR=1.6,p=0.047), Caucasian race (OR=2.3,p=0.001), participation in activities outside of the home (OR=2.0,p=0.04), anterior approach (OR=2.3,p=0.001), and higher baseline quality of life (OR=4.0,p=0.01) were predictive of most satisfaction.
Conclusion : Those most satisfied following surgery for CSM more often held motor and myelopathy complaints, as opposed to numbness complaints. Patients identifying as Caucasian had a higher odds of satisfaction. Those receiving anterior approaches were the most satisfied. Those with shorter symptom durations, ability to participate in activities outside of the home preoperatively, and higher baseline quality of life were the most satisfied. This data supports that earlier operative intervention—prior to CSM having a significant impact on a patient’s quality of life—may be associated with the highest patient satisfaction.
